Lesson 1

Introduction and Overview of Trauma Care and PHTLS

Trauma Overview (1 of 3)

• Worldwide, more than 5.8 million people die from trauma annually– Motor vehicle-related

injuries are the leading cause of trauma deaths

– Ninety percent of the trauma deaths occur in low- and middle-income countries

Trauma Overview (2 of 3)

• In the United States, annually:– 60 million injuries– 40 million emergency department visits– 2.5 million hospitalized– 9 million disabled

• 8.7 million — temporarily• 300,000 — permanently

Trauma Overview (3 of 3)

• In the United States, more than 179,000 people die from trauma annually– It is the leading cause of death in persons

between 1 and 44 years of age• 80% of teenage deaths• 60% of childhood deaths

Cost of Trauma Annuallyin the United States

• Total economic impact of $684 billion Lost productivity from disabilities– 5.1 million years– $65 billion

• Trauma deaths– 5.3 million years of life lost

• Average loss — 34 years per death

– $50 billion

PHTLS Goals

• Reduce mortality and morbidity from trauma

• Provide knowledge and skills for all prehospital trauma team members

• Deliver appropriate care to the trauma patient in the field in a timely fashion – No less– No more

PHTLS Philosophy (1 of 2)

• Trauma care should be based on research• Interventions are based on the

assessment of each trauma patient• Deliver the trauma patient:

– With the appropriate interventions – To the right facility– Utilizing the right mode of transport– In the right amount of time– As safely as possible

PHTLS Philosophy (2 of 2)

• Research provides us with the foundation for the best practices for trauma care– Research may:

• Validate our current practices• Refute our current practices• Determine future practices

Team Approach (1 of 2)

• A diverse team must work together in order to provide trauma patients with the best chance for a favorable outcome © Dan Myers

Team Approach (2 of 2)

• This team includes:– Citizens, dispatch

• System activation

– Emergency medical responders– EMS– Transport services – Emergency department – Surgery– Other specialty services– Rehabilitation

Communication andDocumentation (1 of 3)

• Communication among all trauma team members is critical in ensuring that proper care is provided to the patient– Timely– Verbal– Written

© Jones and Bartlett Publishers. Courtesy of MIEMSS.

Communication andDocumentation (2 of 3)

• Clear, concise, accurate, and complete communication between the prehospital care provider and the receiving hospital facilitates optimal care

Courtesy of Anthony Caliguire, NREMT-P.

Communication andDocumentation (3 of 3)

• Good documentation is required:– To maintain continuity of care

• Copy of prehospital care report left at receiving hospital

– For medical and legal reasons– For trauma research– To support trauma system funding

PHTLS Around the World

PHTLS

• Based on the Advanced Trauma Life Support (ATLS) course by the American College of Surgeons Committee on Trauma (ACS-COT)

• A joint effort between the ACS-COT and the National Association of EMTs (NAEMT)

• First offered in 1983, has been offered in 57 countries, and has trained more than 700,000 providers

PHTLS Course (1 of 3)

• Builds upon each participant’s current knowledge base and skills to enhance critical thinking and problem-solving abilities

• Stresses teamwork between providers with diverse levels of knowledge, skills, and resources

• Provides a structured environment to practice trauma assessment and treatment skills

PHTLS Course (2 of 3)

• We must critically examine everything we do (i.e., how and why)

• Science is always evolving and helps us verify or disprove our approach to trauma care

• Health care providers must be lifelong learners

Medical practices change!

PHTLS Course (3 of 3)

• Based on available research• Updated every 4 years as supported by

new research• Teaches the principles of care rather than

focusing on preferences

Trauma Care (1 of 3)

• Principle is what needs to be done for a patient based upon the assessment

• Preference is how the principle is accomplished– This will change depending on the:

• Situation at the scene• Severity of the patient• Knowledge and skills of the prehospital care

provider• Resources available

Trauma Care (2 of 3)

Based on assessment– Begins long before you reach the patient

• Information provided from the call for help

– Scene and situation• Safe• Available resources • Number of patients

Trauma Care (3 of 3)

– Mechanism of injury (kinematics)– Patient

• Primary assessment• Secondary assessment • Reassessment

Patient Assessment (1 of 2)

• Primary assessment– A-B-C-D-E approach – Taught sequentially, performed

“simultaneously”– Assess for and correct immediate threats to

life• Secondary assessment

– “Head-to-toe” assessment– Assess for all other injuries — usually

non-life-threatening– Includes measurement of vital signs

Patient Assessment (2 of 2)

• Reassessment– Important to look for changes in the patient’s

condition• Response to treatment

– Ongoing to determine any apparent change in patient status

Critical Trauma Patient (1 of 2)

• Primary assessment– Treat at the scene versus treat while en route– Knowing when to do something is important;

knowing when not to do something is even more important

– Reassessment

• Secondary assessment– Only when time and situation allow

Critical Trauma Patient (2 of 2)

• Transport– Ground versus air– Mode of transport

• Emergent versus non-emergent

– Appropriate destination

Potential Pitfalls of Assessmentand Management (1 of 3)

• Not establishing a safe scene• Overlooking life threats by not adequately

assessing or exposing the patient• Focusing on distracting,

non-life-threatening injuries• Performing a secondary assessment prior

to stabilizing all life threats

Potential Pitfalls of Assessmentand Management (2 of 3)

• Performing “advanced” interventions before “basic” procedures

• Not performing a secondary assessment when appropriate

• Prolonged scene times

Potential Pitfalls of Assessmentand Management (3 of 3)

• Overlooking signs of deterioration in a patient who initially appeared noncritical

• Failure to reassess• Transport or destination decision error

Prevention

• Trauma is preventable• Prevention training is available for

everyone• PHTLS faculty and providers should be

advocates for and active participants in trauma prevention programs

• Prehospital care providers are the “eyes” of the prevention effort

Course Mechanics

• Housekeeping• How the course will run• Course expectations• Evaluation process

Questions?